Pneumonia

Criteria of pneumonia:
1-fever
2- respiratory involvement: fever, chill, SOB, cyanosis,
cough, sputum, chest pain, malaise, tachypnia.
3- evidence of parenchymal involvement: (crepitation -
decrease of air entry- radiological x-ray infiltration of lung)

C/C:
fever, chill, SOB ,chest retraction, cyanosis, cough, sputum,
chest pain, malaise, tachypnea {increase respiratory rate}
,retraction, hypoxemia, poor feeding. + duration of
symptoms

history:
1- analysis of complaint symptoms
2- ask if it is 1
st
attack or not (recurrent: maybe it is cystic
fibrosis or immunodeficiency)
3- healthy child or have risk factor (immunodeficiency child
easily take infection)


4-ask about non specific symptoms: other cause of infection:
e.g :
A) meningitis: (fever- headache- neck stiffness- confusion-
irritability- sleepiness- photophobia- vomiting-nausea)
B) Otitis Media: (otalgia {earache} discharge- headache-
cough- rhinorrhea- sinus congestion- fever 40 C lethargy)
C)symptoms of URTI: ( itching of eye- nasal discharge- nasal
congestion- sore throat- fever- cough- headache- sneezing-
fatigue)
D) UTI: ( dysuria- urgency- frequency- enuresis-
incontinence- strong smelling urine - lower ABD
discomfort-flank pain- irritability - hematouria- fever
chill- malaise- vomiting)
E) contact with sick patient
: Vaccine history
Pneumococcal vaccine for streptococcal pneumonia,
influenza vaccine for Haemophilus influenza will help for
prevention.

Examination:
General:
V/S>> RR+ O2 sat.
Growth parameter


NORMAL RR:
0-2 months less than 60 breath/minutes
2-12 months less than 50 breath/ minutes
1-5 years laess than 40 breath / minutes
Well or ill, alert or not, color( pallor, cyanosis), tachypnea,
grunting, active ala-nasi, audible wheezing, stridor, body
built ,connect to O2 or not.
Upper limb: clubbing, periphral cyanosis, puls, blood
pressure.
Face: lips>>peripheral cyanosis tongue>> central cyanosis
Ala- nasi>> active or not.
Respiratory examination:
(Al hawasi book page 115-116-117)
Signs of respiratory distress:
Grade1: tachypnea
Grade2: chest retraction( subcostal, intercostals,
suprasternal, active ala-nasi)
Grade3: Grunting
Grade4: respiratory failyre ( cyanosis, disturbed of
conscouse, convulsion)
By Inspection: of chest movement maybe asymmetrical
movement( decrease movement of affected side)
By Palpation: look for symmetrical or asymmetrical chest
movement.
By Percussion: Dull on affected side ( consolidation)
By Auscultation: crackles or crepitation on the affected side.
ABD>>> tenderness or pain if there is inflammation


Investigation:
-Chest radiography x-ray ( infiltration of lungs)
-Ultrasonography
-Pulse oximetry
-Complete blood cell (CBC) count
-Sputum and blood cultures

Treatment:
ABC
O2 inhalation
Positive pressure ventilation
Uncomplicatied: amoxicillin
2
nd
or 3
rd
generation cephalosporin (Azenthamycin)

DDx:
Pneumonia
Aspiration pneumonia
Bronchopneumonia
Bronchitis
Asthma
Pathogens:
Bacterial: Streptococcus pneumoniae , Haemophilus
influenzae, Staphylococcus aureus,
Viral: rhinoviruses, ,influenza virus, respiratory syncytial
virus (RSV), adenovirus, and parainfluenza




Aspiration pneumonia

similar to pneumonia Presentation of aspiration pneumonia:
but on examination:
Fever or hypothermia
Tachypnea/Tachycardia
Decrease breath sound
Altered mental status
Hypoxemia
Hypotension
Pleural friction rub
Dull on percussion


Investigation
ABG to assess O2 and PH ( dur to low partial pressure of
CO2 >> respiratory alkalosis)
CBC increase WBC and neutrophils and thrombocytosis
And similar to pneumonia

: TTT
ABC
Reassess the need of INTUBATION
In case of lung abscess give AB (clindamycine) otherwise if
he is stable dosen't need medication


DONE BY:
Garni - Areej AL